Organization
CARDIOLOGY CLINICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL M HETTERICH (SENIOR DIRECTOR OF FINANCE, URMFG)
(585) 756-4003
Entity
Organization
Contact information
Practice address
601 ELMWOOD AVE, BOX 679B, ROCHESTER, NY 14642-0001
(585) 275-4751
(585) 473-1573
Mailing address
601 ELMWOOD AVE # 679-B, ROCHESTER, NY 14642-0001
(585) 275-6168
Taxonomy
Speciality
Code
Description
License number
State
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00792190
—
NY
01
—
2190040
INDEPENDENT HEALTH
NY
01
—
CB1630
MEDICARE RAILROAD
NY
01
—
G0185482590
BLUE CHOICE
NY
Enumeration date
06/06/2006
Last updated
04/28/2025
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